年老較大體重較重的女性應該進行雙邊臀部的BMD測量


  Sept. 24, 2003(明尼阿波利斯)--根據一篇研究顯示,評估年老女性的臀部骨骼礦物質密度(BMD) 時,應該要同時測量雙邊而非單側BMD。
  
  這是來自於一位研究人員的建議,因為他發現有高達20%的老年女性臀部有顯著的差異,許多女性的一側臀部有正常的檢測值,但是另一側卻患有骨質疏鬆症,La Plata骨質疏鬆症研究中心的主任Jose Luis Mansur博士表示,有鑑於此,超過60歲以上及71公斤以上的女性,最好測量二邊。
  
  在研究雙邊臀部的BMD研究中,發現女性左右臀之間的BMD有顯著的差異存在,研究人員將此研究結果發表於美國骨骼和礦物質研究學會第 25 個年度會議中。
  
  在本研究中,共有100個停經期後的女性進行(平均年齡60歲)BMD測量,臀部經過評估為正常、患有骨質疏鬆症,有脊椎側彎和服用影響骨骼新陳代謝藥物的女性則排除於研究之外。
  
  在股骨頸部的測量中,81%的女性雙邊臀部一樣,其中有19%是不一致的,14%為一側正常和一側骨質缺少症,5%的臀部為骨質疏鬆症。
  
  在測量總臀部的BMD方面,有84%屬於和諧狀態,16%中是不調和的,11%是正常的或者有骨質缺少症,另外有5%患有骨質疏鬆症。
  
  在100名女性中,40人為60歲以上,總臀部測量有17.5%之結果不一致,股骨頸部的測量中測量的結果有32.5%不一致,較重的體重也有關係,會增加不一致性的可能。
  
  僅管在臀部之間的相互關係是相當高的,但是無脊椎側彎的患者雙邊有顯著的差異存在,20%的檢測結果是不一樣的,這種分類差異會影響治療,他建議更老,體重較重的患者應測量雙測臀部的BMD。
  
  這項結果並不令人訝異,未參與研究的波士頓哈佛醫學院的Marian Hannan教授表示,在諸如 Framingham研究等的大型研究中,流行病學家傾向於只測量一側,但是當大量的數字計算平均時,似乎是一致的。
  
  但是如果你需要應用於治療上,這的確會造成誤判,所以根據一些療養院的資料建議,由左側或右側被攙扶的老年女性,其雙側的BMD便有差異存在,另外個人的移動性也會影響BMD的差異。
  
  另一方面她也指出,測量的程序經常在另外一個位置進行,如此可以彌補未經測量之另一側臀部的資料完整性。

Bilateral Hip BMD Should be Me

By
Medscape Medical News

Pippa Wysong

Sept. 24, 2003 (Minneapolis) — When assessing bone mineral density (BMD) of the hip in older women, measurements should be done for both sides, not just one.

That is the recommendation of a researcher who found that there are significant differences between the hips of up to 20% of older women, with many having normal values on one side and osteoporosis on the other.

"In women who are over 60 years of age and who are heavier, more than 71 kg, two measurements are better," said Jose Luis Mansur, MD, director of the Center for Endocrinology and Osteoporosis in La Plata, Argentina.

In a study investigating bilateral hip BMD, it was found that significant differences between the left and right hip appeared in women who did not have scoliosis or other conditions that could indicate there might be differences. Findings were presented here at the 25th annual meeting of the American Society for Bone and Mineral Research.

BMD was measured in 100 postmenopausal women (mean age, 60 years). Hips were rated as normal, as having osteopenia, or as having osteoporosis. Women with scoliosis and those who had previous treatment with drugs that affect bone metabolism were excluded.

In measurements of the femoral neck, 81% of the women had concordance between both sides. Of the 19% that were discordant, 14% were rated as being either normal or as having osteopenia, and 5% of the hips had osteoporosis.

In measuring total hip BMD, there was 84% concordance. Of the 16% that were discordant, 11% were normal or had osteopenia while 5% had osteoporosis.

Of the 100 women, a total of 40 were older than 60 years, with discordance occurring in 32.5% of the femoral neck measurements and in 17.5% of the total hip measurements. Heavier weight played a role too, increasing the likelihood of discordance, Dr. Mansur said.

"Although the correlation between both hips is high, a significant number of patients without scoliosis have a difference between sides, and nearly 20% are classified in different way if we choose only one side," Dr. Mansur said.

The classification differences could affect treatment decisions. He suggested that older, heavier patients have BMD measured on both sides.

The results are not surprising, said Marian Hannan, DSc, assistant professor of medicine and aging at Harvard Medical School in Boston, Massachusetts. She was not involved in the study.

In large studies such as the Framingham study, epidemiologists tend to want to measure only one side when coming up with values for populations. When large numbers are averaged out, it appears that there is concordance.

But "if you're going to use it for treatment, you may want to take both hips," Dr. Hannan said, because it is more meaningful for an individual patient. Some nursing home data suggest that there can be differences in hip BMD depending on whether a person is left- or right-handed, and how mobile an individual is on either side.

On the other hand, she said, measurements are often done at additional sites, which could make up for not measuring both hips.

Dr. Mansur received no outside funding for this study.

25th ASBMR: Abstract M087. Presented Sept. 22, 2003.

Reviewed by Gary D. Vogin, MD

Pippa Wysong is a freelance writer for Medscape.

    
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